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General NPI Number Information
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NPI Number | 1912125899
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Entity Type | Individual
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Provider Name | COURTNEY ANN JATANA D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 12/18/2019
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Provider Practice Location Address
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Address Line | 305 W. 12TH AVE
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City | COLUMBUS
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State | OH
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Zip | 43210
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Country | US
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Telephone | 614-292-5144
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Fax | 614-292-1103
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Provider Business Mailing Address
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Address Line | 305 W. 12TH AVE. RM 2101
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City | COLUMBUS
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State | OH
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Zip | 43210
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Country | US
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Telephone | 614-292-5144
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Fax | 614-292-1103
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30-023557
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | LIMITED TEACHING
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 30.023557
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License Number State | OH
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